Durvalumab with etoposide and either carboplatin or cisplatin for untreated extensive-stage small-cell lung cancer

Durvalumab with etoposide and either carboplatin or cisplatin is recommended as an option for untreated extensive-stage small-cell lung cancer in adults, only if: • they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and • the company provides durvalumab according to the commercial arrangement . they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and the company provides durvalumab according to the commercial arrangement .

When using ECOG performance status, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect ECOG performance status and make any adjustments needed.

Use the least expensive option of the available treatments (including durvalumab and atezolizumab). Take account of administration costs, dosages, price per dose and commercial arrangements. If the least expensive option is unsuitable, people with the condition and their healthcare professional should discuss the advantages and disadvantages of other treatments.

These recommendations are not intended to affect treatment with durvalumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop. Why these recommendations were made Usual first treatment for extensive-stage small-cell lung cancer is atezolizumab plus etoposide and carboplatin. Durvalumab works in a similar way to atezolizumab and may be offered to the same population. Clinical trial evidence is in people with an ECOG status of 0 or 1 (that is, they are more able to do daily tasks and ordinary activities than those with poorer ECOG status). Durvalumab has not been directly compared in a clinical trial with atezolizumab. Indirect comparisons suggest that durvalumab is likely to work as well as atezolizumab in terms of how long people have before their cancer gets worse and how long they live. A cost comparison suggests that durvalumab has similar or lower costs as atezolizumab, when all relevant costs are taken into account including commercial arrangements. So, durvalumab is recommended. For all evidence see the committee papers . For more information on NICE's evaluation of atezolizumab, see the committee discussion section in NICE's technology appraisal guidance on atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer .

Durvalumab (Imfinzi, AstraZeneca) in combination with etoposide and either carboplatin or cisplatin is indicated for 'the first-line treatment of adults with extensive-stage small cell lung cancer'.

The dosage schedule is available in the summary of product characteristics for durvalumab.

The list price is £592 for a 120‑mg vial and £2,466 for a 500‑mg vial (excluding VAT; BNF online accessed October 2024).

The company has a commercial arrangement . This makes durvalumab available to the NHS with a discount. The size of the discount is commercial in confidence.

Section 7 of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 requires integrated care boards, NHS England and, with respect to their public health functions, local authorities to comply with the recommendations in this evaluation within 90 days of its date of publication. Because durvalumab has been recommended through the cost-comparison process , NHS England and integrated care boards have agreed to provide funding to implement this guidance 30 days after publication.

Chapter 2 of Appraisal and funding of cancer drugs from July 2016 (including the new Cancer Drugs Fund) – A new deal for patients, taxpayers and industry states that for those drugs with a draft recommendation for routine commissioning, interim funding will be available (from the overall Cancer Drugs Fund budget) from the point of marketing authorisation, or from release of positive draft guidance, whichever is later. Interim funding will end 90 days after positive final guidance is published (or 30 days in the case of drugs with an Early Access to Medicines Scheme designation or cost comparison evaluation), at which point funding will switch to routine commissioning budgets. The NHS England Cancer Drugs Fund list provides up-to-date information on all cancer treatments recommended by NICE since 2016. This includes whether they have received a marketing authorisation and been launched in the UK.

The Welsh ministers have issued directions to the NHS in Wales on implementing NICE technology appraisal guidance. When a NICE technology appraisal guidance recommends the use of a drug or treatment, or other technology, the NHS in Wales must usually provide funding and resources for it within 2 months of the first publication of the final draft guidance.

When NICE recommends a treatment 'as an option', the NHS must make sure it is available within the period set out in the paragraphs above. This means that, if a patient has untreated extensive-stage small-cell lung cancer and the healthcare professional responsible for their care thinks that durvalumab is the right treatment, it should be available for use, in line with NICE's recommendations.

Durvalumab with etoposide and either carboplatin or cisplatin is recommended as an option for untreated extensive-stage small-cell lung cancer in adults, only if: • they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and • the company provides durvalumab according to the commercial arrangement . they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and the company provides durvalumab according to the commercial arrangement .

When using ECOG performance status, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect ECOG performance status and make any adjustments needed.

Use the least expensive option of the available treatments (including durvalumab and atezolizumab). Take account of administration costs, dosages, price per dose and commercial arrangements. If the least expensive option is unsuitable, people with the condition and their healthcare professional should discuss the advantages and disadvantages of other treatments.

These recommendations are not intended to affect treatment with durvalumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop. Why these recommendations were made Usual first treatment for extensive-stage small-cell lung cancer is atezolizumab plus etoposide and carboplatin. Durvalumab works in a similar way to atezolizumab and may be offered to the same population. Clinical trial evidence is in people with an ECOG status of 0 or 1 (that is, they are more able to do daily tasks and ordinary activities than those with poorer ECOG status). Durvalumab has not been directly compared in a clinical trial with atezolizumab. Indirect comparisons suggest that durvalumab is likely to work as well as atezolizumab in terms of how long people have before their cancer gets worse and how long they live. A cost comparison suggests that durvalumab has similar or lower costs as atezolizumab, when all relevant costs are taken into account including commercial arrangements. So, durvalumab is recommended. For all evidence see the committee papers . For more information on NICE's evaluation of atezolizumab, see the committee discussion section in NICE's technology appraisal guidance on atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer .

Durvalumab with etoposide and either carboplatin or cisplatin is recommended as an option for untreated extensive-stage small-cell lung cancer in adults, only if: • they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and • the company provides durvalumab according to the commercial arrangement . they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and the company provides durvalumab according to the commercial arrangement .

When using ECOG performance status, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect ECOG performance status and make any adjustments needed.

Use the least expensive option of the available treatments (including durvalumab and atezolizumab). Take account of administration costs, dosages, price per dose and commercial arrangements. If the least expensive option is unsuitable, people with the condition and their healthcare professional should discuss the advantages and disadvantages of other treatments.

These recommendations are not intended to affect treatment with durvalumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop. Why these recommendations were made Usual first treatment for extensive-stage small-cell lung cancer is atezolizumab plus etoposide and carboplatin. Durvalumab works in a similar way to atezolizumab and may be offered to the same population. Clinical trial evidence is in people with an ECOG status of 0 or 1 (that is, they are more able to do daily tasks and ordinary activities than those with poorer ECOG status). Durvalumab has not been directly compared in a clinical trial with atezolizumab. Indirect comparisons suggest that durvalumab is likely to work as well as atezolizumab in terms of how long people have before their cancer gets worse and how long they live. A cost comparison suggests that durvalumab has similar or lower costs as atezolizumab, when all relevant costs are taken into account including commercial arrangements. So, durvalumab is recommended. For all evidence see the committee papers . For more information on NICE's evaluation of atezolizumab, see the committee discussion section in NICE's technology appraisal guidance on atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer .